Preservation therapy for vertically fractured teeth with periodontal tissue regeneration using FGF-2
Masaichiro Iwasaki1, Masahide Takedachi2, Keigo Sawada2
1Private Practice, Iwasaki Dental Clinic, Nara, Japan.
Background:
Vertically fractured teeth often have a poor prognosis, and extraction is considered the most predictable treatment. Conventional management has consisted of preservation therapy involving extraction, bonding, root restoration, and replantation of fractured teeth. However, these methods fail to adequately address the periodontal tissue damage associated with root fractures. This report describes successful periodontal tissue regeneration using basic fibroblast growth factor (FGF-2) combined with a carbonate apatite-based bone graft material (CaAp) as a scaffold during the replantation of vertically fractured teeth.
Methods:
Our series included four patients: a 57-year-old woman, a 59-year-old woman, a 45-year-old man, and a 41-year-old woman, all diagnosed with vertically fractured teeth. The fractured teeth were extracted, bonded using 4-methacryloxyethyl trimellitate anhydride in methyl methacrylate initiated by tri-n-butyl borane (4-META/MMA-TBB) resin, and replanted. CaAp was applied to the extraction sockets; FGF-2 was administered to the periodontal ligament-deficient root areas prior to replantation.
Results:
In all cases, periodontal pocket depths were reduced to 3 mm or less, and no signs of inflammation were evident. Cone-beam computed tomography revealed substantial regeneration of periodontal tissues.
Conclusions:
The combination of FGF-2 and CaAp during the replantation of vertically fractured teeth promotes periodontal tissue regeneration and demonstrates potential for long-term tooth preservation.
Key Points:
What new information do these cases provide? This is the first report to our knowledge demonstrating that replantation of a root-fractured tooth, historically considered suitable only for extraction, can achieve substantial periodontal tissue regeneration. This regeneration was accomplished by bonding and restoring the tooth using 4-methacryloxyethyl trimellitate anhydride in methyl methacrylate initiated by tri-n-butyl borane (4-META/MMA-TBB) resin in combination with fibroblast growth factor (FGF-2) and carbonate apatite-based bone graft material (CaAp). What are the keys to successful management of these cases? Atraumatic tooth extraction Thorough curettage of the extraction socket Comprehensive debridement of the fractured root surface Precise bonding and restoration of the fractured tooth Effective application of FGF-2 and CaAp, with accurate positioning and stabilization of the replanted tooth What are the primary limitations to success in these cases? The mechanical factors that can cause root fracture need to be eliminated for this treatment to succeed. The long-term prognosis depends on consistent follow-up and monitoring. The procedure is highly technique-sensitive; outcomes are closely associated with operator skill and experience.
